Background: Many visits to pediatric emergency departments are sub-acute in severity and could be amenable to a direct-to-consumer telemedicine encounter. The SARS-CoV-2 outbreak has created a unique need for telemedicine as far fewer patients have sought ambulatory in-person care across our entire system. Presumably, many of these patients have problems amenable to telemedicine but are choosing to delay seeking care. Objective: We sought to rapidly develop a direct-to-consumer pediatric virtual urgent care service to enhance access to care for patients and parents during the SARS-CoV-2 pandemic. Methods: To develop our program we enlisted key stakeholders from the division of pediatric emergency medicine, the hospital executive leadership, the hospital telemedicine program, our affiliated health plan administration and an existing virtual urgent care administered by our affiliated division of emergency medicine. We adopted American Well as our telemedicine platform, utilizing their native urgent care software. Families access this service either through a smart device app or a secure website. Providers see patients either in a repurposed ED office with telemedicine equipment or from home using a variety of technology solutions. We staff our service 24/7 with our existing group of pediatric emergency medicine physician assistants and nurse practitioners. Providers and patients were surveyed regarding their experience with the service. Visit data were summarized and analyzed in a Power BI dashboard and in Microsoft Excel. Results: We implemented our program on March 30, 2020 after two weeks of development and training, 19 days after the first case of COVID-19 in our county. In our first 30 days of operation 580 unique visits were completed, 25% of which were from outside our typical ED catchment area. Mean visit duration was 7 minutes and mean wait time was 8 minutes. Mean hourly volumes showed a peak from 10AM to 8PM (see Figure 1). Patients and families (247 responses) were satisfied with the care they received and the quality of the technology, on average rating both 4.9 on a 5 point scale. The most common chief complaints were rash, cold, fever, sore throat and ear pain (see Figure 2). Eighty percent of patients were subscribers of our affiliated health plan. Additional data analysis includes frequency of technical problems, frequencies of the most common diagnoses, frequency of referral for an in-person evaluation, frequency of prescription of any type and for antibiotics (and comparison to national trends), payor details, and frequency of outpatient SARS-CoV-2 testing. Detailed provider and patient surveys are pending. Conclusions: A direct-to-consumer pediatric telemedicine service can be rapidly developed and deployed to respond to a sudden change in needs of a population. This type of service is convenient for families that want to seek care from home and broadly acceptable to patients and providers.

Volume and Visit Metrics

Visits are summed and represented as a histogram by hour. Visit duration (dashed line) and wait time (solid line) are averaged for each hour and represented in aggregate.

Visit Reason Word Cloud

Larger size indicates a more frequent visit reason. The most common visit reasons were rash, cold, fever, sore throat and ear pain.